Changes to stance limb peak, cumulative, and regional plantar foot forces among normal walking and three mobility aids in healthy older adults

Kingston, David G. I.; Linassi, A. Gary; Zucker-Levin, Audrey

doi:10.1016/j.gaitpost.2020.07.015

Cited by 4 publications

(6 citation statements)

References 17 publications

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“… 10 In another study, healthy older adults were tested across walking device use, with a significant difference in net vertical force on the propulsive limb. 11 The crutches were 0.04, 0.03, and 0.07 normalized body weight higher in peak net, midfoot, and rearfoot forces in the last 30-second epoch. 11 Walker use in this study also had significant ( P < .01) differences in the average vertical force (967.74 N) between all the conditions, but shear forces were not reported.…”

Section: Discussionmentioning

confidence: 83%

“… 14 Although assistive walking devices offload the affected foot to promote healing, the contralateral propulsive foot (unaffected limb) has increased loading exposure in healthy older adults. 11 However, shear force exposure occurring on the propulsive foot in those with type 2 DM or the applicability of loading profiles from healthy older adults representing this clinical population is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Gwaltney,

Harrington,

Anguiano-Hernandez

et al. 2024

Foot & Ankle Orthopaedics

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Background: Diabetic patients with foot ulcers are commonly prescribed assistive walking devices to unload the affected foot and promote tissue healing. However, the effect on shear loads to the contralateral foot is unknown. This study investigated the effect of a wheeled knee walker (WKW), compared to common devices, on compressive and shear plantar forces carried by the propulsive foot during walking in patients with type 2 diabetes mellitus. A secondary objective investigated plantar forces’ correlations with body weight unloaded (BWU). Methods: Participants walked a maximum of 200 m per condition during normal walking or when using crutches, a standard walker, and a WKW in randomized order. Plantar forces were measured with force plates, and wireless force-sensitive pads measured BWU through the hands. The WKW was instrumented to measure BWU onto the seat and handlebars. Three-dimensional motion capture confirmed gait events. Results: The WKW produced the lowest vertical, braking, propulsive, and medial shear forces but the highest lateral shear force among all conditions. Using crutches or a walker had negligible medial and lateral shear (mean = −6.69 N and −7.80 N), with normal walking producing the highest medial shear. There was a poor relationship between BWU and assistive walking devices and shear force values. Conclusion: A WKW could be the preferred assistive device for unloading a diabetic foot ulcer. The magnitude of lateral force would need further investigation to determine ulceration risk, given patient susceptibility and neuropathy. Clinical Relevance: Understanding shear forces on the propulsive foot is important for minimizing contralateral limb tissue damage risk while treating an ulcer. Different assistive walking devices change walking patterns and affect shear forces on the plantar surface of the foot. Although the WKW minimizes several loading metrics, a clinical trial investigating assistive walking device compliance and wound healing in diabetic foot ulcer patients across devices is needed.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Gwaltney,

Harrington,

Anguiano-Hernandez

et al. 2024

Foot & Ankle Orthopaedics

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“…9,10 Individuals’ steps were identified within walking conditions using a 50 N threshold (∼7% of mean participant bodyweight) from plantar force timeseries data to avoid false positive step identification when the force sensor deflected within the shoe. 7 The frequency of steps occurring within our 30-second epoch was reported as step frequency for each walking aid. Identified step periods were used to define the percentage of our 30-second epoch that was spent weightbearing.…”

Section: Methodsmentioning

confidence: 99%

“…3,11,14 Major concerns are that walking aid selection may alter stance limb plantar force (SLPF), stepping frequency, and percentage of time weightbearing (% WB), and increase risk of injury. 7 Further, the increased physical demand of using standard walking aids, especially in older adults, negatively impacts user compliance and often results in patient discontinuance. 2 Therefore, standard walking aids may place patients in a dilemma; discontinuance could lead to delayed healing while maintaining use impacts activities of daily living performance.…”

Section: Introductionmentioning

confidence: 99%

“…Anecdotal evidence suggests it may be more stable, easier to use, and reduce SLPF when compared to routinely prescribed walking aids. 7 In healthy young adult populations (24-38 years of age and 35 ± 9 years, respectively), WKW use resulted in approximately 40% less VO 2 intake and 23% lower heat rate compared with a walker or crutches and was preferred over axillary crutches 88% of the time. 8,13 However, a current knowledge gap exists as to whether adults aged ≥50 years and older would experience similar benefits from WKW use.…”

Section: Introductionmentioning

confidence: 99%

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Implications of Walking Aid Selection for Nonweightbearing Ambulation on Stance Limb Plantar Force, Walking Speed, Perceived Exertion, and Device Preference in Healthy Adults 50 Years of Age and Older

Kingston

Ferwerda

Fontaine

et al. 2021

Foot & Ankle Orthopaedics

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Background: Young adults often tolerate the increased energy expenditure, coordination, and stance limb discomfort associated with walking aids for nonweightbearing ambulation. Adults aged ≥50 years may not have the same tolerance. Therefore, the objective of this study was to determine how walking aid selection affects stance limb plantar force, walking speed, perceived exertion, and device preference in adults aged ≥50 years. Methods: A prospective randomized crossover study was performed using healthy adults, aged ≥50 years, with no use of walking aids within 5 years. Participants walked 200 m in 4 randomized conditions: single nonweightbearing ambulation using crutches, a walker, a wheeled knee walker, and unaided walking. An in-shoe sensor measured stance limb plantar force, a stopwatch timed each walk, perceived exertion was reported using the BORG CR-10 scale, and device preference was identified. Results: Twenty-one participants (7 male; age: 56 ± 5 years; BMI: 26.6 ±1.9) showed stance limb plantar force was lowest when using a wheeled knee walker ( P < .001). Walking speed was similar in unaided and wheeled knee walker conditions (1.41 and 1.31 m/s), but slower with crutches or a walker (42%-68%, P < .001). Perceived exertion was similar in unaided and wheeled knee walker conditions (1.6 and 2.8), but higher with crutches or a walker (5.7 and 6.1, P < .001). Most (20/21) participants preferred the wheeled knee walker. Conclusions: Using a wheeled knee walker for nonweightbearing ambulation reduced stance limb plantar force, maintained unaided walking speed and perceived exertion, and was preferred to crutches or a walker. Level of Evidence: Level II, comparative study.

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Hand loading, rates of perceived exertion, and usability during assisted walking in patients with type 2 diabetes mellitus

Anguiano-Hernandez,

Harrington,

Kingston

2023

Clinical Biomechanics

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Changes to stance limb peak, cumulative, and regional plantar foot forces among normal walking and three mobility aids in healthy older adults

Cited by 4 publications

References 17 publications

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Implications of Walking Aid Selection for Nonweightbearing Ambulation on Stance Limb Plantar Force, Walking Speed, Perceived Exertion, and Device Preference in Healthy Adults 50 Years of Age and Older

Hand loading, rates of perceived exertion, and usability during assisted walking in patients with type 2 diabetes mellitus

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